Quantifying The Diagnostic Pathway For Patients With Cognitive Impairment: Real-World Data From Australia

Objectives: Rapid diagnosis of dementia is essential to ensure optimum patient care. This study used real-world data to quantify the dementia diagnostic pathway in Australia. Design: A real-world, cross-sectional survey of physicians and patients. Setting: Clinical practice. Participants: Primary care or specialist physicians managing patients with cognitive impairment (CI). Measurements: Descriptive analyses focused on key events in the diagnostic pathway. Regression modeling compared the duration between first consultation and formal diagnosis with various factors. Results: Data for 600 patients were provided by 60 physicians. Mean time from initial symptoms to first consultation was 6.1 +/- 4.4 months; 20% of patients had moderate or severe CI at first consultation. Mean time from first consultation to formal diagnosis was 4.0 +/- 7.4 months (1.2 +/- 3.6 months if not referred to a secondary physician, and 5.3 +/- 8.3 months if referred). Time from first consultation to diagnosis was significantly associated with CI severity at first consultation; time was shorter with more severe CI. There was no association of disease severity and referral to a secondary physician; 69.5% of patients were referred, the majority (57.1%) to a geriatrician. The highest proportion of patients were diagnosed by geriatricians (47.4%). Some form of test or scale was used to aid diagnosis in 98.8% of patients. Conclusions: A substantial number of Australians experience cognitive decline and behavioral changes some time before consulting a physician or being diagnosed with dementia. Increasing public awareness of the importance of early diagnosis is essential to improve the proportion of patients receiving comprehensive support prior to disease progression.